Comparison of Inter- and Intra-Individual Neuromuscular Patterns of Responses During Moderate-Load Bilateral Leg Extension Exercise

Introduction: This study examined the electromyographic (EMG) and mechanomyographic (MMG), amplitude (AMP) and mean power frequency (MPF) responses during bilateral, leg extension exercise performed to failure at a moderate (70% one-repetition maximum [1RM]) load. Methods: Eleven men completed a 1RM and repetitions to failure at 70% 1RM of the leg extension. The EMG and MMG signals were recorded from the right and left vastus lateralis. Polynomial regression analyses were used to determine individual and composite, normalized neuromuscular responses for both limbs. Results: For EMG AMP, both limbs demonstrated positive, quadratic relationships. For EMG MPF, the right limb demonstrated a negative, cubic relationship and the left limb demonstrated a negative, quadratic relationship. For MMG AMP, the right limb demonstrated a positive, quadratic relationship and the left limb demonstrated a positive, linear relationship. For MMG MPF, both limbs demonstrated negative, linear relationships. 18-45% of the subjects demonstrated the same responses as the composite for the EMG and MMG signals. 14% of the subjects demonstrated the same direction and pattern of response for the right and left limb intra-individual responses. Conclusions: The variability in the inter- and intra-individual responses highlight the necessity to report individual neuromuscular responses when examining fatiguing resistance exercise.

Ipsilateral and Simultaneous Comparison of Responses from Acceleromyography- and Electromyography-based Neuromuscular Monitors

Background The paucity of easy-to-use, reliable objective neuromuscular monitors is an obstacle to universal adoption of routine neuromuscular monitoring. Electromyography (EMG) has been proposed as the optimal neuromuscular monitoring technology since it addresses several acceleromyography limitations. This clinical study compared simultaneous neuromuscular responses recorded from induction of neuromuscular block until recovery using the acceleromyography-based TOF-Watch SX and EMG-based TetraGraph. Methods Fifty consenting patients participated. The acceleromyography and EMG devices analyzed simultaneous contractions (acceleromyography) and muscle action potentials (EMG) from the adductor pollicis muscle by synchronization via fiber optic cable link. Bland–Altman analysis described the agreement between devices during distinct phases of neuromuscular block. The primary endpoint was agreement of acceleromyography- and EMG-derived normalized train-of-four ratios greater than or equal to 80%. Secondary endpoints were agreement in the recovery train-of-four ratio range less than 80% and agreement of baseline train-of-four ratios between the devices. Results Acceleromyography showed normalized train-of-four ratio greater than or equal to 80% earlier than EMG. When acceleromyography showed train-of-four ratio greater than or equal to 80% (n = 2,929), the bias was 1.3 toward acceleromyography (limits of agreement, –14.0 to 16.6). When EMG showed train-of-four ratio greater than or equal to 80% (n = 2,284), the bias was –0.5 toward EMG (–14.7 to 13.6). In the acceleromyography range train-of-four ratio less than 80% (n = 2,802), the bias was 2.1 (–16.1 to 20.2), and in the EMG range train-of-four ratio less than 80% (n = 3,447), it was 2.6 (–14.4 to 19.6). Baseline train-of-four ratios were higher and more variable with acceleromyography than with EMG. Conclusions Bias was lower than in previous studies. Limits of agreement were wider than expected because acceleromyography readings varied more than EMG both at baseline and during recovery. The EMG-based monitor had higher precision and greater repeatability than acceleromyography. This difference between monitors was even greater when EMG data were compared to raw (nonnormalized) acceleromyography measurements. The EMG monitor is a better indicator of adequate recovery from neuromuscular block and readiness for safe tracheal extubation than the acceleromyography monitor. Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New